NHS Ayrshire and Arran Assurance Board minutes: Meeting Three: 18th May 2026

Attendees and apologies

Members

• (SG): Stephen Gallagher, Director of Assurance & Improvement – Chair, Scottish Government
• (FB): Fiona Bennett, Chief Finance Officer, Scottish Government

 

Attendees – NHS Ayrshire and Arran

• (LB): Lesley Bowie, Chair of NHS Ayrshire and Arran
• (GJ): Gordon James, Chief Executive
• (VC): Vicki Campbell, Director of Acute Services
• (CMcG): Crawford McGuffie, Medical Director
• (BS): Brian Steven, Turnaround Director
• (DS): David Stonehouse, Director of Finance
• (JW): Jenny Wilson, Director of Nursing
• (KD): Kirstin Dickson, Director of Transformation & Sustainability
• (CMcA): Craig McArthur, Chief Officer, East Ayrshire Integration Joint Board
• (MI): Mark Inglis, Chief Officer, South Ayrshire Integration Joint Board

Attendees – Scottish Government/other

• [redacted], Unit Head
• [redacted], Policy Official
• (TS): Tracy Slater, Unit Head

 

Apologies 

• (AW): Angie Wood, Director Mental Health, Social Care and NCS, Scottish Goverment
• (CC): Caroline Cameron, Chief Officer, North Ayrshire Integration Joint Board

 

Items and actions

1. Welcome and introductions

SG welcomed members and attendees to meeting three of the assurance board and outlined the agenda. He thanked those who have contributed to the minutes of meeting two on 02 April 2026 and asked for any final comments. There were no further comments so the minutes are accepted.

2. Action Log

Five actions are closed by the meeting as these feature on the agenda:

• AB011: NHS A&A to bring a paper on communications to the assurance board in mid-May
• AB014: NHS Ayrshire and Arran to provide a formal response to paper 3.1 (PMO deep dive actions)
• AB015: Fiona Bennett to draft and share a paper summarising the finance deep dive and associated actions
• AB017: M1 out-turn to be considered at the next assurance board meeting (18 May)
• AB018: Review response to risk paper and feedback

One action was missed in the last meeting, but an update was provided by email:

• AB006: Update on filling the HR post within the programme management office

Update: The workforce post has been readvertised, and shortlisting is complete with an interview process scheduled for 21st May.  We expect a successful outcome from this round of recruitment

Three related actions around partnership working and proposals for utilising the £500k spend should be closed in meeting 4, scheduled for 28 May 2026:

• AB002: AW and GJ to meet to explore more of the detail around involvement and

Three actions are carried forward to future meetings:

• AB004: Add review of vacancy data to a future assurance board agenda
• AB013: Evidence of change control to be brought to future assurance board meetings
• AB016: Meeting in the summer to consider service redesign

These will be timetabled appropriately

Item 3: Q4 review update

DS presented the Q4 financial position, covering the 2025/26 year end outturn and early progress against the 2026/27 financial plan. Key highlights were noted such as an overspend of £24.3 million for 2025/26, within the agreed deficit support level, alongside strong delivery of savings against the national target, although a shortfall remained against the Board’s internal target.

DS noted that strengthened governance arrangements are now in place, including the establishment of new delivery structures, which are supporting improved oversight and pace of financial recovery. He also noted the early progress on the 2026/27 Best Value plan, alongside a remaining savings gap and a range of associated risks, including reliance on system-wide delivery, cost pressures and potential slippage in savings schemes.

With regard to Operational Improvement Plan (OIP) funding, NHS Ayrshire and Arran have worked collaboratively with the integration joint boards and have agreed to carry forward the maximum resources into next year. The health board have discussed the need to firm up commitments, strengthen delivery confidence and maintain momentum in progressing the financial plan. Next steps include finalising budgets, improving financial tracking and enhancing engagement across the organisation to support delivery. The health board have also discussed key financial risks, including the savings gap, slippage on delivery and the need to strengthen confidence in identified schemes. Particular attention was given to risks within the OIP space and the importance of managing these effectively.

FB reflected on the same points, highlighting positive progress, particularly the improvement in recurrent savings compared to previous periods. It was also noted that deficit support remains at the maximum level available.

GJ confirmed that the Quarter 4 letter has now been received and will be shared with chief executives. It was also noted that the OIP planning assumptions and planned care letter have also been received, with work underway to develop delivery trajectories.

Item 4: M1 outturn This item relates to action AB017.

DS presented the April 2026 Financial Management Report. It was noted that the organisation reported a £4.0 million overspend at Month 1, with figures being high level and subject to further refinement in subsequent weeks. The health board remains at level 4 of the Scottish Government performance framework and is operating within an agreed deficit plan, with significant efficiency savings required to achieve the 2026/27 financial target.

DS highlighted early progress against the efficiency programme, recognising the scale of the full year savings requirement and associated risks in delivery. Continued focus on strengthening financial grip, monitoring and delivery of savings was emphasised. Key issues were noted from a run-rate perspective, noting that the temporary nursing pay bill remains a significant pressure and can fluctuate on a month-to-month basis. It was highlighted that March is typically a higher-cost month, with April reflecting a lower position. Bank and agency nursing usage is beginning to reduce, with further improvement expected through the implementation of e‑rostering.

FB advised that Month 1 out-turn is not normally relied upon as a definitive indicator of financial performance; however, given the current position, the early view is helpful. It was noted that a more formal assessment will be undertaken at Month 3.

SG sought clarification on vacancy controls and their operation in Month 1. DS confirmed that analysis of payroll data, including joiners and leavers between January and March, is being undertaken.

DS noted that there has been a reduction in headcount, including around 100 posts across the system, with an estimated reduction of approximately 60 whole time equivalents.

BS confirmed that the NHS Ayrshire and Arran team have linked with counterparts in NHS Grampian on procurement and will have an evidence base to support this.

JW shared slides to describe bank hours work from April 2025 to April 2026. A deep dive on agency/bank hours is going to be scheduled. Underlying reasons for supplementary spend are clear and that will subject to workforce solutions for the improvement plan for next year.

SG thanked DS for producing the Month 1 position and for the level of effort and clarity provided. The assurance board noted that improved grip and control measures are signalled in the early data, including increased levels of financial sign-off through the system and the positive impact this is having on staffing and control processes. The assurance board would welcome seeing similar analysis for Month 2, and then aligning with the establishing reporting patterns from Month 3 onwards.

 

Item 5: Finance deep dive + actions This item relates to action AB015.

FB introduced the paper summarising the recent finance deep dive and associated actions, building on the verbal update provided at the previous meeting. 

The deep dive reviewed the 2026/27 savings programme in detail, with a line-by-line assessment of delivery confidence, risks and assumptions. It was noted that while there is strong confidence in a number of high-value savings areas, a significant delivery gap remains alongside a proportion of schemes assessed as medium or low confidence. It was also noted the scale of the financial challenge and the need to strengthen reporting to reflect the full savings requirement, alongside improving clarity on delivery timescales, risks and mitigation.

A number of actions were identified to support delivery, including further validation of savings, development of additional pipeline opportunities and continued monitoring through regular finance governance arrangements.

It was highlighted that the best-value plan, particularly schemes within the high-confidence category, is supported by robust planning, with significant effort required to ensure delivery.

LB advised that non-executive directors are assured on the current position, noting the scale of the financial gap and the importance of maintaining focus as the organisation moves forward.

GJ advised that work is underway to improve theatre efficiency, including development of theatre templates and further work on job planning.

VC confirmed confidence in theatre scheduling at the planning stage, noting the need to ensure full alignment as the work progresses.

The assurance board noted the work underway and encouraged colleagues in NHS Ayrshire and Arran to continue to look at how to close the savings gap.

Item 6: PMO This item relates to action AB014.

FB provided an update on the response to the PMO deep dive actions, noting progress across a range of actions to strengthen the savings programme, including increased pace and oversight through weekly best-value meetings and continued development of pipeline savings opportunities.

It was noted that further work is underway to improve delivery confidence, including deep-dive workshops to identify additional opportunities, acceleration of programmes where possible and continued review of savings approaches across other health boards.

Actions to strengthen financial governance, including clearer reporting on savings assumptions, tighter controls on new investment proposals and ongoing monitoring through established finance processes were also noted.

Progress on the ‘Caring for Ayrshire’ programme and development of supporting business cases was noted, alongside plans to continue monitoring delivery and provide further updates to the assurance board.

KD noted that updates had been provided against each of the actions. Closing the gap to meeting the financial targets for 2026-27 is a key priority moving forward. NHS Ayrshire and Arran are looking to cover a number of areas with potential opportunity – eg: flow assurance, reducing non-delay length of stay, reviewing the number of beds. Workshops relating to sub-national planning will be held through May and June, bringing wider teams and service leads into the conversation. Leads are thinking about 2027-28 planning processes as well. Revised budget setting processes mean there are very limited circumstances where business cases would be considered. Savings opportunities need to be aligned to any business cases, with clear links from investment to visible gain.

The ‘Caring for Ayrshire’ delivery group will meet on 21 May 2026 with the general medicine team to review demand modelling. The emergency medicine team are fully engaged in the development of the strategy and service models.

The internal audit report was received last week, and is going to audit and risk committee tomorrow (19 May 2026). FB said it will be helpful to see internal audit report.

SG thanked for the update. The assurance board will be grateful to receive the internal audit report when it is published, and health finance (capital) remain open to discussing capital assumptions.

Item 7: Communications This item relates to action AB011.

KD presented a draft communications paper highlighting the importance of clear, consistent messaging to support confidence, culture and delivery across the organisation. The initial phase of the best-value programme and the delivering ‘Caring for Ayrshire’ work was also discussed.

Examples of communication activity included weekly briefings to NHS board members and regular newsletter were discussed.

KD confirmed that the Forth Valley communications approach had been reviewed and reflected on their use of dynamic and interactive tool, and how this might be adopted in NHS Ayrshire and Arran.

SG thanked KD for the paper and the examples of communication activity, including across integration joint board responsibilities. The importance of strengthening cross-linkages in communications was highlighted, alongside the need to refresh elements of the narrative to ensure consistency and support challenge.

SG suggested consideration be given to wider staff engagement, including all-staff calls, sometimes referred to as “town hall” events, to further evidence engagement. The assurance board would like to be invited to observe examples of engagement activity. SG would also welcome the opportunity to engage directly with the NHS board to update them on the work of the assurance board.

Action: Stephen Gallagher to be invited to a meeting of the NHS Ayrshire and Arran board

Action: Assurance board members to be advised on any wider staff engagement events that would be suitable for them to observe

It was also noted that it would be beneficial to engage with the employee director and Fiona Hogg to better understand their perspective on the work of the assurance board. It was recognised that these avenues could provide additional assurance on how key challenges are being communicated and understood across the organisation.

Action: Fiona Hogg and Stephen Gallagher to meet Employee Director.

Item 8: Feedback on risk response This item relates to action AB018.

FB went through the risk response feedback that has been received. There were 13 actions in the original paper. Five of these were closed:

• RA006 asked for the risk register, and this had been provided
• RA010 asked for sight of the risk appetite implementation plan and this had been provided
• RA012 asked what benchmarking was done in developing the risk approach – detail had been provided, and a report of self-assessment shared.
• RA005 asked how often the risk register goes to the ARC. It was confirmed that this happens every six months, in June and December.

• RA008 asked for the risk appetite statement, and details around the development of this between August 2024 and December 2025. The statement has been shared. CMcG confirmed that development involved a short-life working group, including benchmarking against the national HIS framework, and ongoing engagement through a directors of risk and governance network for continued benchmarking. CMcG agreed to provide a written summary with further detail as additional assurance.

 

There was further discussion around two actions:

• RA007 asked why the risk register isn’t available in meeting papers. It was confirmed that the risk register is discussed in closed session twice per year. The assurance board questioned whether this was consistent with other boards’ approaches and whether there is scope to increase transparency around this. Some quality assurance work will be commissioned.
• RA013 asked about the risk registers of integration joint boards, and whether the health board considered these alongside their own risk register. It was confirmed that the risk committee meets quarterly to review risks at a strategic level, including consideration of integration joint board risks. There was some concern as to the appropriateness of health board meeting papers including risk papers from other boards, although it was noted that some integration joint boards and local authorities do publish their risk registers.

 

Action: Angie Wood to undertake some quality assurance of other boards’ approach to handling integration joint boards’ risk registers, and particularly whether these are published or not, and discussed in open or closed sessions.

The remaining six actions all remain open, with further updates to follow

Item 9: AOB

There were no requests for AOB.

Jack Gillespie, Colin Neil and Fiona Hogg  will join the next meeting.

Date of next meeting is 28 May 2026 and will be in Ailsa Hospital in Ayrshire at 10:00.